Cognitive Behavioral Therapy in Adults with Obsessive-Compulsive Disorder and Borderline Intellectual Functioning: A Case Series of Three Patients

Cognitive-behavior therapy (CBT) is widely accepted as the most effective psychological treatment for obsessive-compulsive disorder (OCD). Although this modality flexibly treats a variety of OCD symptom subtypes, it is unclear how CBT should be adapted to meet the needs of individuals with OCD and limitations in their cognitive functioning. In this paper, we report on three adults with borderline intellectual functioning who received CBT following a protocol that was adapted to meet their unique developmental and intellectual needs. For the purposes of this case study, the following modifications were made to a standard treatment CBT protocol: 1) increased parental involvement, 2) simplified language, 3) decreased reliance on cognitive techniques, and 4) the addition of contingency management strategies and role modeling by caregivers. All three adult patients benefited from treatment as evidenced by significant reductions in their OCD symptoms at post-treatment. Conclusions from these cases are drawn, as well as directions for future research.